AB1564-HPR ULTRASOUND EXAMINATION AND INTRA-ARTICULAR INJECTIONS BY A RHEUMATOLOGY NURSE SPECIALIST.
Authors: A. Brink Walling
Journal: Annals of the Rheumatic Diseases (2022)

Background At The Department of Medicine, section of Rheumatology, Odense University Hospital (OUH) Svendborg, we consult patients with rheumatoid arthritis, psoriatic arthritis and gout. The patients can have joint inflammation. Therefor need joint assessment by ultrasound, arthrocentesis and / or IA injection. Ultrasound examination, arthrocentesis and administration of intra-articular (IA) injections for rheumatic disease represent an expansion of the nurse’s role. A previous study has shown, that trained nurses can perform satisfying and safe IA injections at least as well as those administered by doctors (1). High availability to adequate treatment will have a positive effect. For the patient and on a socio-economic level, as patients who have severe arthritis could be forced to stay home from work and leisure activities (2). It was decided to educate a nurse, who showed interest in ultrasound and IA injections and who showed the technical skills. Objectives To educate and develop competence in the nursing staff regarding ability to perform joint ultrasound, arthrocentesis and IA injection. In order to offer immediate arthritis treatment and free up doctor time to be able to see other patients. Methods At first, the nurse watched the ultrasound, arthrocentesis and injection on the knee performed by a rheumatologist a couple of times. Then she performed the procedure under supervision and then she independently performed the ultrasound, arthrocentesis and injection on the knee with the opportunity for supervision. The nurse completed a two-day muscular/skeletal ultrasound course at university hospital Skejby. The course was both theory and hands-on training in an auditorium and was held by a radiologist and a rheumatologist. The nurse has furthermore participated in a course at Esbjerg hospital for doctors and nurses about ultrasound on upper extremities. This was a hands-on course. In conjunction with arthrocentesis, the nurse learned to identify urate crystals in synovial fluid through microscopy. Results See Table 1 for which joints where the nurse performed ultrasound, arthrocentesis and injection during the first and second year. Table 1. Year 1 Joint Ultrasound Arthrocentesis IA injection PIP 10 4 MCP 9 7 WRIST 23 15 ELBOW 1 1 KNEE 50 41 50 ANKEL 7 9 MTP 5 4 In all 102 41 90 Year 2 Joint Ultrasound Arthrocentesis IA injection PIP 10 9 MCP 35 37 WRIST 32 35 ELBOW 12 3 12 KNEE 69 66 80 ANKEL 18 1 17 MTP 28 2 23 In all 203 72 204 One year after the procedure was implemented the joints that the nurse perform ultrasound and injections on, had increased. Starting with only knees to PIP, MCP, wrist, elbow, knees, ankles and MTP joints. After the first year, the nurse grew independent and confident with the new task, as the table beneath shows. Since the nurse started to perform ultrasound, arthrocentesis and IA injections, there has been no reports of adverse events. Conclusion Nurses can be trained to perform ultrasound, arthrocentesis and injections, in a wide range of joints. Patients and staff express satisfaction with the availability of treatment. There has been no reports of adverse events. References [1]Edwards J, Hannah B, Brailsford-Atkinson K , et al. Intra-articular and soft tissue injections: assessment of the service provided by nurses Annals of the Rheumatic Diseases 2002; 61: 656-657. [2]The impact of rheumatoid arthritis and treatment on patients’ lives V. Strand1 and D. Khanna article.pdf Acknowledgements I want to thank Rheumatologist Søren Just and Rikke Asmussen for helping me with this abstract. I also want to thank nurse specialist Pia Toftegaard for her input about the nursing perspectiv. Disclosure of Interests None declared